Respiratory system part 1
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Respiratory system-part 1 . Marilyn Rose RT, RDMS. Outline Part 1. Physiology of Respiratory System Internal devices Congenital Hereditary Inflammatory Diffuse Lung disease. Physiology. Role= oxygenation of blood and removal of carbon dioxide

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Respiratory system part 1

Respiratory system-part 1

Marilyn Rose RT, RDMS


Outline part 1

Outline Part 1

  • Physiology of Respiratory System

  • Internal devices

  • Congenital Hereditary

  • Inflammatory

  • Diffuse Lung disease


Physiology

Physiology

  • Role= oxygenation of blood and removal of carbon dioxide

  • Upper- outside thorax- nasopharynx, oropharynx, larynx- passage of air into lower system

  • Lower- within thoracic cavity- trachea, bronchi and bronchioles

  • Trachea branches into two bronchi at the carina

  • Tracheobronchial tree- lined with mucous membrane- cilia

  • Gas exchange

  • external respiration- at alveoli- (cluster- acinus) parenchyma of lung

  • internal respiration- O2 from alveoli- blood capillaries attach to Hb and circulates to the body tissues.


Respiration

Respiration

  • CO2 – waste product of cell metabolism- opposite direction- blood capillaries, alveoli and exit body at expiration.

  • - CO2 regulate the respiratory center (medulla) to stimulate diaphragm/ intercostals to contract- decreased lung pressure forces air out.

  • Lung has two blood supplies-

  • pulmonary circulation-low pressure/ low resistance- O2 enter CO2 exit

  • bronchial circulation- high- O2 blood to lung

  • Double walled membrane

  • 2 layers of pleura-

  • visceral-inner- adhere to lung

  • parietal- inner chest wall

  • Potential space between pleura – surfactant

  • fluid can collect from inflammatory/neoplastic process


Internal device

Internal device

  • Endotracheal tube

  • crx always taken post placement- ensure proper placement 5-7 cm above carina (flexion/ extension will move 2 cm cranial/ caudal)

    • too low? Extend in Rt bronchus- cause lt lung atelectasis

    • too high? Gastric dilation- regurgitation/ aspiration pneumonia

  • Central venous catheters

    • inserted into subclavian VEIN

    • optimal location of tip is where brachiocephalic veins join- SVC

    • xray- medial to anterior border of first rib

    • measure central venous pressure

    • conduit for rapid transfusion

  • Swan-Ganz– measures cardiac output- placed in the pulmonary artery- radiopaque strip

  • Transvenous Cardiac Pacemakers

  • maintain cardiac rhythm with heart block or bradyarrhythmias positioned at the apex of Rt ventricle


  • Congenital hereditary diseases

    Congenital/ hereditary diseases

    • Cystic fibrosis

      • excessive viscous mucus by exocrine glands

      • Defective gene on chromosome 7

      • Most common among white children

      • 90% morbidity rate from respiratory

      • CF affects pancreas/ GI/ and Liver

  • Hyaline Membrane Disease

    • Idiopathic respiratory distress syndrome

    • most common cause of respiratory distress in newborn (premature)

    • Underaeration of lungs due to lack of surfacant

    • Radiographic-

      • Ground glass appearance of parenchyma

      • air bronchogram

    • Treatment- artificial surfactant and + pressure ventilator


  • Cystic fibrosis

    Cystic fibrosis

    • Radiographic-

    • Thick hilar markings- serial CT

    • Treatment

      • Prophylactic antibiotics

      • Chest physiotherapy

      • bronchodilators

    • Lungs

      • Mucous plugs lead to focal area of lung collapse

      • Common recurrent pulmonary infections

      • abdomen

      • Digestion of fat impaired by blockage of ducts at pancreas

      • prevent digestive enzymes from entering duodenum

      • skin

      • Sweat glands- excessive perspiration= “sweat test”


    Inflammatory disorders upper

    Inflammatory disorders- upper

    • Croup

      • Viral infection of young children

      • Inflammatory obstructive swelling at subglottic trachea

      • Causes- stridor or barking cough

      • Radiographic- soft tissue neck x-ray= hourglass shape from edema

      • Treatment- cool mist/ steam from a hot shower

  • Epiglottitis

    • Acute infection caused by haemophilus influenzae

    • Cause thick epiglottic tissue

    • Decreased from the vaccine for type B (HiB) routinely used

    • Radiographic- epiglottis looks like an adult thumb

    • The condition can result in complete airway obstruction


  • Inflammatory disorders lower

    Inflammatory disorders- lower

    • Pneumonia

    • Anthrax

    • Lung abscess

    • TB

    • Pulmonary Mycosis

    • RSV

    • SARS

    bacterial

    viral

    TB


    Pneumonia

    pneumonia

    • inflammation of lung by bacteria or viruses

      • Alveolar-

        • inflam exudate replaces air- affected lung solid

        • consolidation of parenchyma- air bronchogram sign

        • no airway obstruction

      • Bronchopneumonia-

        • small patches of consolidation-

        • airway obstruction- atelectasis- no air bronchogram

        • scattered opacities

      • Interstitial

        • Viral- affects walls and lining of alveoli

        • linear or honeycomb lung

      • Aspiration

        • Aspirate esophageal or gastric contents-

        • general anesthesia risk-

        • multiple alveolar densities- posterior segments of up/ lower lobes are most affected

    alveolar

    interstitial

    aspiration


    Anthrax

    anthrax

    • Caused by a sporelike microbe

    • biologic terrorist attacks in 2001 caused its return

    • Cutaneous, inhalation and gastrointestinal routes of entry

      • Cutaneous- most common- working with animal hides

      • GI route causes mesenteric adenopathy

      • Inhaled anthracis is most lethal –

        • germinating in lung and lymph nodes

        • Mediastinal widening

        • Pleural effussions (w/o infiltrates)


    Lung abscess

    Lung abscess

    • Necrotic area of pulmonary parenchyma containing purulent material

    • Can be complicated by pneumonia, bronchobst, aspiration, foreign body or septic embolism

    • Clinically- fever and cough - copious sputum

    • Complication is a brain abscess

    • On xray a spherical density with a hazy border- can develop into an air/ fluid level


    Respiratory system part 1

    TB

    • Mycobacterium tuberculosis-

      • bacteria- wax coat- live outside the body for long time

      • Spreads by droplets in the air- sometimes by dried sputum inhalation

      • Primarily disease of the lungs but can involve the GI and skeletal system

  • Initial infection-

    • inflam cells collect around bacteria form a tubercle-

    • depending on number and resistance for the outcome

  • Good resistance

    • fibrous tissue surrounds “tumor” prevents spread- scar in the apical segment / calcium deposits

    • The core becomes necrotic- then a liquefied cavity (air/fluid level)

  • low resistnce

    • diffuse distruction throughout the lung- huge cavities and fatal


  • Types of tb

    Types of TB

    • Primary TB-

      • lobar, air-space consolidation, dense, well defined, hilar nodes, pleural effussion- apical lordotic position is used

  • Miliary TB-

    • dissemination of the disease by the bloodstream- nodules distributed to both lungs

  • Secondary TB-

    • reactivation from dormant tubercles- decrease in immune system- hazy radiating form the hilum of lung

  • Tuberculoma-

    • sharp circumscribed parenchymal nodule that can develop primary or secondary- break down anytime and disseminate the disease


  • Pulmonary mycosis

    Pulmonary mycosis

    • Fungal infection of the lung

      • Histoplasmosis (Mississippi River Valley/ Ohio River)

        • Radiographic appearance = similar to TB- but benign

        • Fibrosis in mediastinum

        • Can cause obstruction-

          • svc, pulm art/ veins, narrow esophc

        • Ca++ of liver, spleen, and lymph nodes- diagnostic!!!

      • Coccidioidomycosis( Desert of SW United States)

      • Spread by fungal spore in air

      • Symptoms similar to influenzae

      • Chronic dx= lung abscess

      • Mult areas of pulm infiltration- lower lung- hilar lymph node

      • Lymph node Ca++ = popcorn

      • 3cm low lobe with ca++ w/in mass


    Rsv and sars

    RSV and SARS

    • Respiratory syncytial virus

      • Affect almost all children by age 2

      • Fewer than 2% need to be hospitalized

      • Lower respiratory infection

      • necrosis of epithelium- bronchiolitis

      • Obstruction, interstitial pneumonia

      • Radiographic- hyperinflation, >interstitial markings

  • SARS= severe acute respiratory syndrome

    • Global 2003- 1st in China

    • Droplet- upper and lower infection

    • Cough, hypoxemia, fatal 3%

    • Radiograph- lungs appear normal

      • progress to patchy infiltrates- consolidation


  • Diffuse lung disease

    Diffuse lung disease

    • COPD

      • Chronic obstruction of airway- two disease processes coexist

        • Chronic bronchitis- excessive mucus- leads to obstruction of airway

          • 90% cigarette smoke, sever coughing and sputum production-

          • narrow airways and over inflation of lungs

          • Radiographic-

            • dirty chest- increased bronchovascular markings

        • Emphysema- distention of air spaces- destroy alveolar walls- asthma

          • Result is bronchiectasis- chronic dilation of bronchi

          • Destructive changes in small airways lead to increased volume of air in lungs

          • Radiographic-

            • flattening of domes of diaphragm, > retrosternal air, barrel chest, >vascular markings

            • Bullae- air containing cystic spaces

      • Cause- cigarette smoke, air pollution, occupational exposure


    Asthma and bronchiectasis

    Asthma and Bronchiectasis

    • Asthma

      • Widespread narrowing of the airways due to > responsiveness to allergens

        • Extrinsic- dust, pollen, animal dander, foods

        • Intrinsic- exercise, heat/ cold, emotional upset

        • Radiographic-

          • acute= no abnormalities

          • Chronic= dirty chest with normal vascular markings

    • Bronchiectasis

      • Permanent abnormal dilation of one or more large bronchi

      • Destroy elastic walls

      • Recurrent episodes of pneumonia/ hemopysis

      • Radiographic- circular cystic spaces or honeycomb


    Sarcoidosis

    Sarcoidosis

    • Multisystem granulomatous disease

    • Young adults

    • Multiple epithelioid granulomas

    • Radiographic- usually found on screening CXR

      • Symmetric hilar lymph node enlargement, diffuse interstitial pattern

      • Skeletal lesions in small bones of hands and feet

      • Some patients have elevated serum calcium= lead to nephroca++


    Pneumoconiosis

    Pneumoconiosis

    • Prolonged occupational exposure to irritating particulates

      • These inhaled foreign substances

      • malignant neoplasm

      • Severity depends on size, length of exposure, concentration in atmosphere

  • Silicosis- most common

    • inhalation of silicon dioxide- mining, foundry and sandblasting or quartz dust

    • Rad- eggshell at periphery

  • Asbestosis-

    • Improperly protected workers engaged in handling building materials, insulation composed of asbestos

    • Major complication= mesothelioma- malignant pleural tumor

    • Rad-ca++ of linear pleural plaques

  • Anthracosis

    • Coal miner- working with anthracite- hard coal

    • Black lung

    • Rad- hyperinflated and homogeneous mass at hilar

    • region


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